Yvette Coleman

• Seasoned manager adept in overseeing medical management departments to ensure fully integrated and strategically aligned operations. Highly experienced in working with work-at-home service development and identifying and addressing client needs. Proven success in coordinating multiple teams across various locations to ensure consistency and accuracy of outcomes.
• Worked closely with organizational leadership and medical directors to guide operational strategy, convey organizational mission to staff and support ongoing organizational directives. Supervised and evaluated the activities of medical, nursing and clerical personnel.
• Optimized operational processes using analytical tools to address departmental and organizational specific metrics. Supervised, audited and maintained all utilization review documentation through designated UM system. Developed and maintained excellent knowledge of software programs, design, implementation and upgrade processes.
• Extensive understanding of overall Health Plan accreditation standards and role of medical management within the Health Plan.

• Provided management and supervision of day to day activities for the care management department.
• Assisted in strategic planning, program development and education activities for the team.
• Assist with implementation efforts to focus on case management, nursing care planning, disease-specific care management and population health management.
• Supported and lead continuing efforts to maintain URAC certification.
• Collaborated with management team for structure and testing of all care management systems.
• Assisted in preparing the budget as well as departmental reports such as cost savings, monthly case management activity, excess loss reports, reinsurance reports, etc.
• Maintained responsibility for care management utilization and quality improvement programs at the department level.

• Developed and implemented training programs for new and existing employees to assure consistency and thoroughness of all functions.
• Audited work products of team members to ensure appropriateness and accurate pertinent documentation. Conducted oversight of case-by-case negotiation of fees with non-contracted providers for members in case management.
• Worked with network management to assure that appropriate contracts were in place to support case management referrals.
• Coordinated and communicated with other departments or personnel to assure consistent interpretation and application of case management procedures.
• Assisted with preparation for URAC implementation for the health plan by 2014.

• Provided disease management services through the QCARE program.
• Functioned as a liaison for QCARE with day system vendor EDOC.
• Provided disease management services for QualChoice employees.
• Communicated with utilization review and case management for member referrals.
• Utilized Facets claims system for review of member claims, eligibility and accumulators.
• Researched cost analysis on member data through MEDai population health system.
• Provided data entry for prior authorizations in the PBM system when needed.
• Assisted Care Management Manager with oversight of staff while in the team lead role.

Performed utilization management and case management services in collaboration with a local third party administrator company.

• Managed the development/implementation of care plans within scope of practice for adult and pediatric clients.
• Consulted with third party representatives regulating patient financial responsibilities.
• Provided outstanding support to entire staff which helped improve process flow and boosted efficiency

• Supervised forty plus per diem employees for home health care cases.
• Performed annual in-service training to ensure compliance with state regulations.

• Functioned as primary nurse for the coordination of care for acute and chronic patients with emphasis on family education and transition patients to home setting.
• Provided nursing care for neonates, toddlers and older pediatric patients in medical surgical, ventilator dependent unit.